01120002 UITY
opv SONO
BUILDING iNPERMIT CONTRACTOR INFORMATION: '
'"ITYff"IISTLLCREST RD FOUR SEASONS ROOFING PERMIT NO. y 01120002
'ffT) TANLEY TRUSTEE 645 HORNING ST Al2c/T03j2001
PHONE' (408) 278-0330 SANITARY NO. CONTROL NO.
O ARCHITECfYENGINEER: BUILDING PERMIT INTO
m BLDG ELECT PLUMB MECH
n E LICENSED CONTRACTOR'S DECLARATION
3 In<mbyamrmmat1amhaenzcaangerprovismmaarcnapter9mommeacing REROOF. Job Description
„tai with season 70001 of oi�ai ohne Buaions mad Pmresonv s Code,aan icon t,
-.alxsn iammurnreea r�taS T/O SHAKE, INSTALL 30 YR. COMP.
License sz Lic,p
y 3 o V Dag Consra<wr
ARCHITECT'S DECLA
g I unaemand my plans shall be used as pub is record
eR O O Licensed Professional
OWNER-BUILDER DECLARATION
1 hereby from that 1 am exempt from the Commcmr's License Law for the
following rmwn.(Section 7031.5.Business dna Professions Code:Any city memm,
se '
O wl' h requires a pernot to construct,alter,improve,demolish, p m
any snruure
oar3$ .pr r t issuance, I requirestheapplicant f 1,ern t t fl gned stmement - ---- - -_"-- - -- - -
mtbe, alcenkdpa rinothe pro siossf th<C nmcmrs License Lw(Chapter9' _ _ � Sq:•Ft. Floor Area�• T'1 Valuation
(c mending with Section]000)of Division J f the Basmas.and Professions Code) 1, {, w" ,1 t , s.y f s
or that he is exempt therefrom and the basis for the alleged exemption.Any violation 3 2 6
-of5ecome 7031:5 by any appllcanr cora pemm,indjects the applica mit civil penalty'
050 . 0
of net roam than five hundred dollars(SUIm. APN Number Occupancy Type
❑Lag owner ohne propcnY•urmy<mployax with wages avheir gale compcnsatian, 305 - FRAME
will do the work;andmestructure is not intended or offered for sale(see.70,114, 3 07 - INSULAT
'Business and Professions Code.The Contractors License Law all not apply ha en WZlitired Inspections'
owner°(proPmy Who builds m improves tlurcan,and who does aam warn himself 601 - ROOF TEAR OFF
or through his own employees.provided that such Improvements me not intended to
bfrrrial far sale:If.M1bwcver.-do building or improvement is sold within one yeam of .. - -"-6 0 2 =-.ROOF PLYWOOD—NAIL - -..-... - ' -"'._-----_.
icompletion,the oho-winger will have the burden of proving that he did not wud or 603 - ROOF BATTENS ,
mprove papro
_. . - 604ROOF IN-PROGRESS _.._
L2 L.,owner of the property,am exclusively usnmctngwthlicensedcontractors to r
conswcr the project(Sec 7044,flexions and Proms ons Code)The Contractor's it I
License Law does not apply to an owner of propeny who hu Ids or p thereon
and who aormarts,for such pm)ects with a conoucmds)licensed pursuantto the .. ... .. _. .. ._. .._ .__ ._
Contractors d law,
❑lam exempt pt under Sm. � � B&PCfor this 1 yi-
_ Owva .`Date. . .
WORKER'S COMPENSATION DECLARATION Iz
i� I hereby aRnn under penalty of perjury one of the following declarations:
❑ 1 hove and will maintain a Certificate of Consent to selLinsute for Worker's D
(7°mpensmion, as provided far by Seem. 37W of the Labor Code, for the /
Performance of the work for which this Permit is named. -
°1 have and will maintain Worker',Co pan t Insurnme n required by Serfinor
37W of the Ladoor Code for the gpirforromence of he work for which this Permit is
iss uM.'My W k rs,C pcnat nsvtnncec < a J Pnbe mberem.
Cortvr .,CIiRTITICA9'ION'OFsEXEMPTION'PROMWORKERS �— 't s v L E t.l ria r I l r'i `_r rt ... r is �, '''t• ,t l i
COMPENSATION INSURANCE',
„
_.. _- .._. ..... .__-.. J'.
(This union need not be complied if the permit is for one hundred dollars •' f C '•' '\ ;'
•,fS100)or less.)
_ _ -n
1 mfY met in Ne performan a or the work for which ran penin e,Worker I;
shall not employ i nY person is any manner an tom become s iapsa tq the Workers
Compensation laws ofCalifornia:Date
NOTICE TO APPLICANT:If.eta,making this Certificate of Exemption,you should `• s i" '�
Q 0 become subject to the Workers Compensation provisions of the Labor Code,you must
forthwith limply with such provisions or Nis permit shall be deemed moilod.
F'0 ' '"-CONSTRUCTION LENDING AGENCY - "_ ... ._ _ .. . .. _. _ __ o.
i ---.
1 WQti o , h mhy B'ram th' s a construction n I dnyynkency fmda ce
f,hework
for
whch the permit I, C)
Ld N i_ . . . .;.•u_4-n.
. . ... . . ._ .. .._...._. .. ._... _ . .. -. .. __. ._.
1. Z Ccnd Addresp
s t..) I codify mat 1 have read this application and sone that the above infonniuon is
W'Fy •correct.1 agree,o comply with all city and county ordinances and stem laws relating
C 4.7 to building construction,and hereby avthorine representatives ofthis city to enter upon
W the alsve-menimned pmpcny mr,inspection purposes.
(We)imom save,indemnify and keep hamiless the City'of Cupottio against
fr :4 liabilities,judgments,costs and expenses which may inany ways acerae against said
V Z City in consequence of te tng fm pe n. - " ,
Mp
APP '.TUN R S AND WI LL COLYWITH'ALL NON-POINT", Issued by: - Date
SOl y�
Sgaature bl t ro :t Date. Re-roofs
HAZARDOUS MATERIALS DISC LOSi1RE'
�' ', ( `� �•� ./ (J
` t g core axim share r h rade hararaw mai m .. Type of Roo -- _ ... -..... .
Will the apPlicont or(more building __. .
m def d bynM1 Cupcn M n p I Cod Ch p 9 11 d N H Ira and S f ty i .,
Code.'soon 25532001 ., . • '( F .h11.• ;�,i.'f l I a1 d.,.
❑Yes .. s v�No.f 7 . .1k
goccupantr, q proem All roofs shall be mspec[ed,prior eofany roofing.matenal being installed ----------
Willvices hien If a roof is installed without first obtaining an inspection I'agreeto'remove
emrh dons air contaminant a didmodh the Ba Area Air QualityManagement
D <wumq meant rt bald yYa== '°r°e all new materials for inspection. Applicant understands and will comply with.__
` J °y"'-, °N° all non-p6in4 source regulations.'-
V : •I hove readthe havrd°oi materials requomorisunde/Chapter 6. Sf the
California Health'&Safety Code, rs
Sections 15505:15533 and 15534.1 undeand than
ifflebuilifir,does not art
cartery have atnom Chant limy iesp°nsblitymndtify the --
occu f the requirem which men ba, et p or t°issuance of a Cenifi t,of
ail pa< .. _ - . _
Signature of Applicant Date
m ,gin, t D„g All roof coverings to be Class"B”of better''
.OFFICE ,.. .. _. _. ..._ ... ..
Owner math r